According to the American Association for the Study of Liver Diseases guidelines,
liver resection is not recommended for multiple hepatocellular carcinomas, although
it is performed in Asian countries, including Japan. However, the maximum number,
location, and recurrence types of tumors have not been reported in detail.
This retrospective study analyzed data for 1,170 patients who underwent surgical resection
for hepatocellular carcinoma between October 2002 and December 2020 in a Japanese
tertiary care hospital. Statistical analysis was performed to compare the surgical
short-term and long-term outcomes among patients with >3 tumors and those with ≤3
This study of patients who underwent liver resection identified 775 who had a single
tumor and compared overall survival rates with 477 who had multiple hepatocellular
carcinomas: 242 had 2 hepatocellular carcinomas, 79 had 3 hepatocellular carcinomas,
and 74 had >3 hepatocellular carcinomas. The median survival times based on the number
of tumors were 9.74 years for a single tumor, 6.36 years for 2 tumors, 7.21 years
for 3 tumors, 3.31 years for 4 tumors, and 3.48 years for 5 tumors. The median survival
time was significantly worse in patients with >3 tumors than in those with 3 tumors
(P < .0001). Concerning the type of treatments for recurrence, the patients who underwent
surgical treatment had significantly better survival after recurrence than patients
who underwent other treatments (8.32 vs 3.19 years; P < .001).
The overall survival after liver resection was significantly worse for patients with
>3 tumors than for those with <3 tumors. However, liver resection can be recommended
for patients with 2 or 3 hepatocellular carcinomas because an acceptable median survival
(>5 years) can be expected.